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General NPI Number Information
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NPI Number | 1982657433
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Entity Type | Organization
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Legal Business Name | IVYREHAB SEPT, LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 5301 PROVIDENCE RD SUITE 80
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4128
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Country | US
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Telephone | 757-467-4604
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Fax | 757-467-2716
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Provider Business Mailing Address
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Address Line | PO BOX 412307
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City | BOSTON
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State | MA
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Zip | 02241-2307
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Country | US
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Telephone | 914-294-4050
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL RUCKER
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Credential |
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Telephone | 914-294-4050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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